Drug may help ease headaches during Ramadan: study

NEW YORK (Reuters Health) - A cousin of the drug Vioxx may help prevent headaches in Muslims fasting for Ramadan, according to a new study from Israel.

People taking the non-steroidal anti-inflammatory (NSAID) medicine, known as etoricoxib (Arcoxia), reported fewer and less severe headaches during the first week of the month-long holiday, which began on August 1st this year.

The Ramadan fast lasts from dawn to dusk each day, when those participating do not eat or drink.

About four in every ten people who fast get headaches, said Dr. Michael Drescher from Hartford Hospital in Connecticut, one of the authors of the new study.

Doctors aren't quite sure what causes the headaches. It could be dehydration, Drescher said, or caffeine withdrawal in people who are used to getting their morning coffee. "There's probably more than one thing going on," he told Reuters Health.

Drescher and his Israel-based colleagues had already shown that Jews who took the drug before fasting for 25 hours on Yom Kippur got fewer headaches than those who didn't (see Reuters Health story of January 14, 2010.)

Arcoxia, a COX-2 inhibitor, isn't approved for use in the United States because the Food and Drug Administration decided it was too similar to Vioxx, a drug Merck pulled from the market in 2004 when it was linked to a higher risk of heart attacks. But Arcoxia is available in Israel, among other countries.

The drug has a longer-lasting effect than some other painkillers - which is important because taking a pill in the middle of the day when a headache sets in would be considered breaking the fast.

"If you take Tylenol (before dawn) ... by the time you get around to feeling the effects of the fast, the medicine is long out of your system," Drescher explained.

To see how Arcoxia would work during Ramadan, the researchers assigned 222 adults planning to fast in 2010 to take either the drug or an inactive placebo pill just before the start of fasting each day. All participants recorded how often they had a headache during the day and how severe it was.

After a week, they switched treatments -- so people who had previously taken Arcoxia took the placebo instead, and vice versa.

During the first day of fasting -- when headaches are thought to be most common -- 21 percent of people taking Arcoxia reported having a headache, compared to 46 percent of those who took the placebo pill.

The Arcoxia group also reported fewer total headaches during that first week, the researchers wrote in the journal Headache. And when they did have headaches, they rated them as less severe than participants taking the placebo.

After a week, there was no longer any difference in symptoms between the groups, partly because even people taking the placebo reported fewer headaches during fasting as time went on.

Drescher said that's a finding that has been noticed before. "As to why exactly it happens, we don't know. Perhaps the body goes through some sort of desensitization to the fasting," he explained.

He added that although the researchers didn't contact any Muslim religious authorities about use of the drug during fasting, none of the participants voiced any objection to it.

When they previously talked to rabbis about use of Arcoxia during Yom Kippur, the Jewish leaders pointed out that not having a headache could allow people to be "freer spiritually" and that, "the religious edict to fast really is not a command to suffer," Drescher said.

The study was funded by Merck, which makes the drug, and two of the study's authors are company employees.